Recognizing Mania, Hypomania and Bipolar Depression

We all have our ups and downs, but with bipolar disorder, these peaks and valleys are more severe. The symptoms of bipolar disorder can hurt your job and school performance, damage your relationships, and disrupt your daily life. And although it’s treatable, many people don’t recognize the warning signs and get the help they need. Since bipolar disorder tends to worsen without treatment, it’s important to learn what the symptoms look like. Recognizing the problem is the first step to getting better.

What is bipolar disorder?

Bipolar disorder (also known as manic depression) causes serious shifts in mood, energy, thinking, and behavior—from the highs of mania on one extreme, to the lows of depression on the other. More than just a fleeting good or bad mood, the cycles of bipolar disorder last for days, weeks, or months. And unlike ordinary mood swings, the mood changes of bipolar disorder are so intense that they interfere with your ability to function.

During a manic episode, a person might impulsively quit a job, charge up huge amounts on credit cards, or feel rested after sleeping two hours. During a depressive episode, the same person might be too tired to get out of bed, and full of self-loathing and hopelessness over being unemployed and in debt.

The causes of bipolar disorder aren’t completely understood, but it often appears to be hereditary. The first manic or depressive episode of bipolar disorder usually occurs in the teenage years or early adulthood. The symptoms can be subtle and confusing; many people with bipolar disorder are overlooked or misdiagnosed—resulting in unnecessary suffering. But with proper treatment and support, you can lead a rich and fulfilling life.

Myths and Facts About Bipolar Disorder

Myth: People with bipolar disorder can’t get better or lead a normal life.

Fact: Many people with bipolar disorder have successful careers, happy family lives, and satisfying relationships. Living with bipolar disorder is challenging, but with treatment, healthy coping skills, and a solid support system, you can live fully while managing your symptoms.

Myth: People with bipolar disorder swing back and forth between mania and depression.

Fact: Some people alternate between extreme episodes of mania and depression, but most are depressed more often than they are manic. Mania may also be so mild that it goes unrecognized. People with bipolar disorder can also go for long stretches without symptoms.

Myth: Aside from taking medication, there is nothing you can do to control bipolar disorder.

Fact: While medication is the foundation of bipolar disorder treatment, therapy and self-help strategies also play important roles. You can help control your symptoms by exercising regularly, getting enough sleep, eating right, monitoring your moods, keeping stress to a minimum, and surrounding yourself with supportive people.

Signs and symptoms of bipolar disorder

Bipolar disorder can look very different in different people. The symptoms vary widely in their pattern, severity, and frequency. Some people are more prone to either mania or depression, while others alternate equally between the two types of episodes. Some have frequent mood disruptions, while others experience only a few over a lifetime.

There are four types of mood episodes in bipolar disorder: mania, hypomania, depression, and mixed episodes. Each type of bipolar disorder mood episode has a unique set of symptoms.

Signs and symptoms of mania

In the manic phase of bipolar disorder, feelings of heightened energy, creativity, and euphoria are common. People experiencing a manic episode often talk a mile a minute, sleep very little, and are hyperactive. They may also feel like they’re all-powerful, invincible, or destined for greatness.

But while mania feels good at first, it has a tendency to spiral out of control. People often behave recklessly during a manic episode: gambling away savings, engaging in inappropriate sexual activity, or making foolish business investments, for example. They may also become angry, irritable, and aggressive—picking fights, lashing out when others don’t go along with their plans, and blaming anyone who criticizes their behavior. Some people even become delusional or start hearing voices.

Hypomania symptoms

Hypomania is a less severe form of mania. People in a hypomanic state feel euphoric, energetic, and productive, but they are able to carry on with their day-to-day lives and they never lose touch with reality. To others, it may seem as if people with hypomania are merely in an unusually good mood. However, hypomania can result in bad decisions that harm relationships, careers, and reputations. In addition, hypomania often escalates to full-blown mania or is followed by a major depressive episode.

Common signs and symptoms of mania include:

Feeling unusually “high” and optimistic OR extremely irritable

Unrealistic, grandiose beliefs about one’s abilities or powers

Sleeping very little, but feeling extremely energetic

Talking so rapidly that others can’t keep up

Racing thoughts; jumping quickly from one idea to the next

Highly distractible, unable to concentrate

Impaired judgment and impulsiveness

Acting recklessly without thinking about the consequences

Delusions and hallucinations (in severe cases)

Signs and symptoms of bipolar depression

In the past, bipolar depression was lumped in with regular depression, but a growing body of research suggests that there are significant differences between the two, especially when it comes to recommended treatments. Most people with bipolar depression are not helped by antidepressants. In fact, there is a risk that antidepressants can make bipolar disorder worse—triggering mania or hypomania, causing rapid cycling between mood states, or interfering with other mood stabilizing drugs.

Despite many similarities, certain symptoms are more common in bipolar depression than in regular depression. For example, bipolar depression is more likely to involve irritability, guilt, unpredictable mood swings, and feelings of restlessness. People with bipolar depression also tend to move and speak slowly, sleep a lot, and gain weight. In addition, they are more likely to develop psychotic depression—a condition in which they’ve lost contact with reality—and to experience major disability in work and social functioning.

Common symptoms of bipolar depression include:

Feeling hopeless, sad, or empty.

Irritability

Inability to experience pleasure

Fatigue or loss of energy

Physical and mental sluggishness

Appetite or weight changes

Sleep problems

Concentration and memory problems

Feelings of worthlessness or guilt

Thoughts of death or suicide

Signs and symptoms of a mixed episode

A mixed episode of bipolar disorder features symptoms of both mania or hypomania and depression. Common signs of a mixed episode include depression combined with agitation, irritability, anxiety, insomnia, distractibility, and racing thoughts. This combination of high energy and low mood makes for a particularly high risk of suicide.

The different faces of bipolar disorder

Bipolar I Disorder (mania or a mixed episode) – This is the classic manic-depressive form of the illness, characterized by at least one manic episode or mixed episode. Usually—but not always—Bipolar I Disorder also involves at least one episode of depression.

Cyclothymia (hypomania and mild depression) – Cyclothymia is a milder form of bipolar disorder that consists of cyclical mood swings. However, the symptoms are less severe than full-blown mania or depression.

Treatment for bipolar disorder

If you spot the symptoms of bipolar depression in yourself or someone else, don’t wait to get help. Ignoring the problem won’t make it go away; in fact, it will almost certainly get worse. Living with untreated bipolar disorder can lead to problems in everything from your career to your relationships to your health. Diagnosing the problem as early as possible and getting into treatment can help prevent these complications.

If you’re reluctant to seek treatment because you like the way you feel when you’re manic, remember that the energy and euphoria come with a price. Mania and hypomania often turn destructive, hurting you and the people around you.

Basics of bipolar disorder treatment

Bipolar disorder requires long-term treatment. Since bipolar disorder is a chronic, relapsing illness, it’s important to continue treatment even when you’re feeling better. Most people with bipolar disorder need medication to prevent new episodes and stay symptom-free.

There is more to treatment than medication. Medication alone is usually not enough to fully control the symptoms of bipolar disorder. The most effective treatment strategy for bipolar disorder involves a combination of medication, therapy, lifestyle changes, and social support.

It’s best to work with an experienced psychiatrist. Bipolar disorder is a complex condition. Diagnosis can be tricky and treatment is often difficult. For safety reasons, medication should be closely monitored. A psychiatrist who is skilled in bipolar disorder treatment can help you navigate these twists and turns.

Self-help for bipolar disorder

While dealing with bipolar disorder isn’t always easy, it doesn’t have to run your life. But in order to successfully manage bipolar disorder, you have to make smart choices. Your lifestyle and daily habits have a significant impact on your moods.

Get educated. Learn as much as you can about bipolar disorder. The more you know, the better you’ll be at assisting your own recovery.

Seek support. It’s important to have people you can turn to for help and encouragement. Try joining a support group or talking to a trusted friend. Reaching out is not a sign of weakness and it won’t mean you’re a burden to others. In fact, most friends will be flattered that you trust them enough to confide in them, and it will only strengthen your relationship.

Monitor your moods. Keep track of your symptoms and watch for signs that your moods are swinging out of control so you can stop the problem before it starts.

Bipolar disorder and suicide

The depressive phase of bipolar disorder is often very severe, and suicide is a major risk factor. In fact, people suffering from bipolar disorder are more likely to attempt suicide than those suffering from regular depression. Furthermore, their suicide attempts tend to be more lethal.

The risk of suicide is even higher in people with bipolar disorder who have frequent depressive episodes, mixed episodes, a history of alcohol or drug abuse, a family history of suicide, or an early onset of the disease.

The warning signs of suicide include:

Talking about death, self-harm, or suicide

Feeling hopeless or helpless

Feeling worthless or like a burden to others

Acting recklessly, as if one has a “death wish”

Putting affairs in order or saying goodbye

Seeking out weapons or pills that could be used to commit suicide

Important

It’s very important to take any thoughts or talk of suicide seriously. If you or someone you care about is suicidal, call the National Suicide Prevention Lifeline in the U.S. at 1-800-273-TALK or visit IASP or Suicide.org to find a helpline in your country.

Bipolar disorder causes and triggers

Bipolar disorder has no single cause. It appears that certain people are genetically predisposed to bipolar disorder, yet not everyone with an inherited vulnerability develops the illness, indicating that genes are not the only cause. Some brain imaging studies show physical changes in the brains of people with bipolar disorder. Other research points to neurotransmitter imbalances, abnormal thyroid function, circadian rhythm disturbances, and high levels of the stress hormone cortisol.

External environmental and psychological factors are also believed to be involved in the development of bipolar disorder. These external factors are called triggers. Triggers can set off new episodes of mania or depression or make existing symptoms worse. However, many bipolar disorder episodes occur without an obvious trigger.

Stress – Stressful life events can trigger bipolar disorder in someone with a genetic vulnerability. These events tend to involve drastic or sudden changes—either good or bad—such as getting married, going away to college, losing a loved one, getting fired, or moving.

Substance Abuse – While substance abuse doesn’t cause bipolar disorder, it can bring on an episode and worsen the course of the disease. Drugs such as cocaine, ecstasy, and amphetamines can trigger mania, while alcohol and tranquilizers can trigger depression.

Seasonal Changes – Episodes of mania and depression often follow a seasonal pattern. Manic episodes are more common during the summer, and depressive episodes more common during the fall, winter, and spring.

Sleep Deprivation – Loss of sleep—even as little as skipping a few hours of rest—can trigger an episode of mania.

More help for bipolar disorder

Bipolar Disorder Help Center: Learn what you need to know to recognize the problem, manage symptoms, balance your mood, and lead a full and meaningful life.

Causes of bipolar disorder

What other readers are saying

“I was diagnosed with unipolar depression at age 19, and took various antidepressants until age 26 with no success. I was then hospitalized and diagnosed as a mixed episode, rapid cycling bipolar, with no idea of what that meant. This website took the doctor-speak of my illness and made it understandable to me [so] I can take better care of myself.” ~ Arizona

“Thank you for your informative article. I have been struggling for years with misdiagnosis of my symptoms. I’m so grateful that I don’t have to live this way the rest of my life. This fits my symptoms perfectly.” ~ North Carolina